Provider Demographics
NPI:1477372654
Name:SOUTHERN BANKS BABY, PLLC
Entity type:Organization
Organization Name:SOUTHERN BANKS BABY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:R
Authorized Official - Last Name:HINES
Authorized Official - Suffix:
Authorized Official - Credentials:RN, IBCLC
Authorized Official - Phone:252-499-2232
Mailing Address - Street 1:540 PARK MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28570-8199
Mailing Address - Country:US
Mailing Address - Phone:910-984-6020
Mailing Address - Fax:
Practice Address - Street 1:225 PROFESSIONAL CIR STE A
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-2996
Practice Address - Country:US
Practice Address - Phone:252-499-2240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty